Open AccessEfficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation
Author(s) -
Chan YiHsin,
See LaiChu,
Tu HuiTzu,
Yeh YungHsin,
Chang ShangHung,
Wu LungSheng,
Lee HsinFu,
Wang ChunLi,
Kuo ChangFu,
Kuo ChiTai
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.008150
Subject(s) - medicine , apixaban , rivaroxaban , dabigatran , warfarin , atrial fibrillation , vitamin k antagonist , hazard ratio , stroke (engine) , propensity score matching , retrospective cohort study , cardiology , anesthesia , confidence interval , mechanical engineering , engineering
Background Whether non–vitamin K antagonist oral anticoagulants ( NOAC s) are superior to warfarin among Asians with nonvalvular atrial fibrillation remains unclear. Methods and Results In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, there were 5843, 20 079, 27 777, and 19 375 nonvalvular atrial fibrillation patients taking apixaban, dabigatran, rivaroxaban and warfarin, respectively, from June 1, 2012 to December 31, 2016. Propensity‐score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any efficacy or safety outcome or the end date of study. Hazard ratios (95% confidence intervals) comparing apixaban, dabigatran, and rivaroxaban with warfarin were: ischemic stroke/systemic embolism ( IS / SE ), 0.55 (0.43–0.69), 0.82 (0.68–0.98), and 0.81 (0.67–0.97); major bleeding, 0.41 (0.31–0.53), 0.65 (0.53–0.80), and 0.58 (0.46–0.72); and all‐cause mortality, 0.58 (0.51–0.66), 0.61 (0.54–0.68), and 0.57 (0.51–0.65). A total of 3623 (62%), 17 760 (88%), and 26 000 (94%) patients were taking low‐dose apixaban (2.5 mg twice daily), dabigatran (110 mg twice daily), and rivaroxaban (10–15 mg once daily), respectively. Similar to all‐dose NOAC s, all low‐dose NOAC s had lower risk of IS / SE , major bleeding, and mortality when compared with warfarin. In contrast to other standard‐dose NOAC s, apixaban was associated with lower risks of IS / SE (0.45 [0.31–0.65]), major bleeding (0.29 [0.18–0.46]), and mortality (0.23 [0.17–0.31]) than warfarin. Conclusions All NOAC s were associated with lower risk of IS / SE , major bleeding, and mortality compared with warfarin in the largest real‐world practice among Asians with nonvalvular atrial fibrillation. All low‐dose NOAC s had lower risk of IS / SE , major bleeding, and mortality when compared with warfarin. Standard‐dose apixaban caused a lower risk of IS / SE , major bleeding, and mortality compared with warfarin.